Worthy to Serve the Suffering’ Alpha Omega Alpha and the movement to reform medical education

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Worthy to Serve the Suffering’

Alpha Omega Alpha and the movement to reform medical education
By Don W. Powell
An early advocate of professionalizing medical education, the lone national honor medical society in the United States, Alpha Omega Alpha (AOA) is now one hundred years old. The Texas Alpha Chapter of AOA at UTMB, the first chapter founded in the state of Texas, is eighty-two.
Many leaders in medicine are AOA members, including 70 per cent of U.S. deans of medical schools and chairs of medicine. There are currently 123 AOA chapters among the 134 U.S. and Canadian medical schools. Just one sixth of the graduating class may be elected, and they must be in the top quarter academically. Criteria also include leadership, fairness, compassion, integrity, and service.
When AOA was launched, there were too many U.S. medical schools, and too few were truly professional. In 1900, 160 U.S. medical schools trained over 25,000 students and they were a motley crew: Even Harvard’s were said to be “noticeably inferior in bearing, manner and discipline to students in other departments.” One older student at the University of Illinois, William W. Root, aimed to improve medical students’ professionalism and also to “protest against” their “rowdyism, boorishness, immorality, and low educational ideals.” In August 1902, with eight senior classmates, he founded Alpha Omega Alpha.
Stressing scholarship and professionalism, AOA quickly caught on. Chapters quickly sprang up in Chicago and at other leading medical schools; UTMB’s chapter, founded in 1920, was the twenty-fifth.
Between 1900 and 1920, the National Board of Medical Examiners was formed, the Association of American Medical Colleges was started, and the American Medical Association (AMA) flourished. The Carnegie Foundation hired Abraham Flexner to assess the quality of American medical education; he visited every state and nearly every medical school. The 1910 Flexner Report recommended reducing the number of medical school and required a college degree for admission. By 1920, when UTMB first required a college degree, there were just eight-five American medical schools.

Flexner was critical of most Texas medical schools. He visited Galveston in November 1909 and was more approving. Flexner reported that the UT Medical Department had 206 students, a teaching staff of twenty-six, and nine professors. Three professors and seven instructors, he wrote, were full-time and on salary. He praised the school’s “complete series of admirable teaching laboratories covering anatomy, physics, chemistry, physical chemistry, pathology, bacteriology, histology and embryology.”

Flexner was “pleased to find a large pathological museum labeled and indexed and a notable anatomical museum in which special preparations are most advantageously arranged for teaching use.” He reported the library “good and in regular receipt of foreign and domestic journals” and added, “Experimental animals were in abundance.” The university hospital had 155 beds and good laboratories, he said, and he judged the school “well organized.”

However, Flexner complained about minimal research and failure to utilize students actively on the wards. He said the dispensary—equivalent to the modern emergency room—was ill-organized and lacked enough attending physicians. He also found that patient record keeping was inadequate.

Flexner’s most damning criticism was of the school’s location: “To an outsider it seems a regrettable mischance that located the medical department away from the university. Were it placed in Austin, it would apparently gain in every other way: the town is as large, and various state institutions there would strengthen its clinical opportunities. It would be easier to attract and to hold outsiders in teaching positions: the stimulus to the university would assist the growth of a productive spirit. Whether at Galveston the school will ever be creative is a question. Should it become so, isolation increases the liability to slip back into an unproductive groove. Perhaps it is not too late for the people of the state to concentrate their institution of higher learning in a single plant.”

Dean of Medicine W. S. Carter wrote to the President of the University of Texas, Dr. S. E. Meyes, in April 1910, protesting that Galveston’s population was actually 38,850, not 34,355 as Flexner stated; that there were five full-time professors, not three; and that the problem with the dispensary occurred, in part, because the City of Galveston allowed charity patients to enter the dispensaries without a permit from city health officials. The hospital solved the patient records problem by assigning that duty to the intern staff.

It was harder to rebut Flexner’s criticism of the minimal local research effort. In 1903, the former Dean, A. J. Smith, presciently had observed: “The medical school at Galveston, the most southern medical institution in the United States and one closely related to the tropics by trade conditions, is in an exceptional position for the study of tropical and subtropical diseases….Such work should be done as a justification for the existence of the school.” (Finally, eighty-four years later, in 1994, the World Health Organization Collaborating Center for Tropical Disease was founded at UTMB, and in subsequently Smith’s suggestion was embraced even more enthusiastically. )
Galveston medical students began to meet to discuss forming an AOA chapter in May 1920. Later that year Dr. William Root wrote: “…your school has received unanimous approval of our Committee on Extension, and also the unanimous approval of our 24 chapters and, in a consequence, a charter goes forward under separate cover, suitably signed and sealed.” In November 1920, Root visited Galveston to acquaint himself with the new chapter.
The founders of AOA stressed that race, color, creed, gender and social standing should not be barriers to membership. In an early letter to the Galveston students, Root singled out two potential AOA members: “I was glad to see two girls on your list. If they come up to the mark, they must be included.” They did, and they were.
Since 1920, many UTMB students have been elected to AOA. Some whose names appear in the AOA files of the Blocker History of Medicine Collection are Courtney Townsend, Sr., the father of our current chair of surgery, Courtney Townsend, Jr., himself later elected to AOA at UTMB; William Levin, UTMB president emeritus; Gretchen Herrmann and Thomas M. Runge, the parents of Marschall Runge, our previous director of cardiology; Joe Painter, a past president of the AMA and currently an active member of UTMB’s Development Board; Ruth Baxter, who practices internal medicine in Galveston; and Herb Seybold, who went on to found the Kelsey-Seybold Clinic in Houston. Others were Jim Guckian, Interim Vice Chancellor of Medical Affairs for the University of Texas System; Gene Sarles; Jay Fish; Jim Thompson; Al LeBlanc; Mel Schreiber; and Ron Deskin, Randy Goldblum and Joan Richardson, all past or current UTMB faculty.
UTMB has been active in the leadership of AOA nationally. One of our medical students, Richard Bonner (now a resident in orthopedics at UT-Southwestern), was elected as a student member to the National Board of Directors in 2000.
In addition to choosing medical students, AOA also elects residents and fellows, alumni, faculty, and honorary members each year. Important AOA programs are the Pharos, the quarterly literary magazine; sponsorship of visiting professorships, student research fellowships and student essay contests; compilation of descriptions of leaders in American medicine; and a national Distinguished Teaching Award. The goals of AOA have not changed in the last hundred years, nor has its motto: “Worthy to serve the suffering.”
Don W. Powell, M.D., associate dean for research in the School of Medicine, was appointed recently to AOA’s National Board of Directors.

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